Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will allow Maine to cut back the eligibility standards in the QMB, SLMB, and QI programs for disabled Mainers, beginning March 1, 2013. Specifically, a provision of the Affordable Care Act requires a "maintenance of effort" (MOE) in a state's Medicaid program, which means that Medicaid eligibility standards cannot be reduced until the state's Exchange is operational. 42 U.S.C. § 1395a(gg)(1). The MOE requirement does not apply, however, and therefore a reduction in eligibility standards is allowed if a state certifies that it has a budget deficit; this exception is only applicable to "nonpregnant, nondisabled adults" with incomes over 133% of the federal poverty level. 42 U.S.C. § 1395a(gg)(3).

Relief sought: Declaratory and injunctive relief, including a temporary restraining order and a preliminary injunction, requiring the Secretary to rescind approval of the state plan amendment.

Updated: February 21, 2014

Status: On February 21, 2013, plaintiffs filed their Motion for a Temporary Restraining Order (TRO) and Preliminary Injunction, and their Motion for Class Certification. Plaintiffs contend that, because they and the class they seek to represent are disabled and their incomes are under 133% of the federal poverty level, the exception to the MOE requirement does not apply to them and the Secretary improperly approved the state plan amendment. On February 28, the judge denied the TRO. He ruled in effect that, although plaintiffs’ interpretation of the statute was plausible, they had not carried their burden of showing a likelihood of success on the merits.

In May 2013, the parties briefed cross-motions to dismiss and for summary judgment. On September 30, 2013, the court issued its decision. — F.R.D. —, 2013 WL 5448157. Although the parties had agreed that there was no need for the state to be in the case, and the state had shown no interest in participating, the court concluded, on standing grounds and under Rule 19 of the Federal Rules of Civil Procedure, that the case could not proceed without the state’s participation. The court gave plaintiffs the opportunity to move to amend the complaint to bring state officials into the case, but plaintiffs chose not to. The court dismissed the complaint without prejudice on October 17, 2013. Plaintiffs did not appeal.

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